Digital Therapeutics Alliance’s Post

Here is the updated the physician fee schedule proposed rule. The section below relates directly to SDoH. Services Addressing Health-Related Social Needs (Community Health Integration Services, Social Determinants of Health Risk Assessment, and Principal Illness Navigation Services) For CY 2024, CMS is proposing coding and payment changes to better account for resources involved in furnishing patient-centered care involving a multidisciplinary team of clinical staff and other auxiliary personnel. These proposed services are aligned with the HHS Social Determinants of Health Action Plan and also help implement the Biden-Harris Cancer Moonshot goal of every American with cancer having access to covered patient navigation services. Specifically, we are proposing to pay separately for Community Health Integration, Social Determinants of Health (SDOH) Risk Assessment, and Principal Illness Navigation services to account for resources when clinicians involve community health workers, care navigators, and peer support specialists in furnishing medically necessary care. While these care support staff have been able to serve as auxiliary personnel to perform covered services incident to the services of a Medicare-enrolled billing physician or practitioner, the services described by the proposed codes are the first that are specifically designed to describe services involving community health workers, care navigators, and peer support specialists. Community Health Integration (CHI) and Principal Illness Navigation (PIN) services involve a person-centered assessment to better understand the patient’s life story, care coordination, contextualizing health education, building patient self-advocacy skills, health system navigation, facilitating behavioral change, providing social and emotional support, and facilitating access to community-based social services to address unmet social determinations of health (SDOH) needs. Community Health Integration services are to address unmet SDOH needs that affect the diagnosis and treatment of the patient’s medical problems. Principal Illness Navigation services are to help people with Medicare who are diagnosed with high-risk conditions (for example, mental health conditions, substance use disorder, and cancer) identify and connect with appropriate clinical and support resources. CMS is further clarifying that the community health workers, care navigators, peer support specialists, and other such auxiliary personnel may be employed by Community-Based Organizations (CBOs) as long as there is the requisite supervision by the billing practitioner for these services, similar to other care management services. If you are a physician practice or physician management group that needs assistance with your SDoH process. Please contact us to see the most advanced process in the industry. https://lnkd.in/eFMieDKg

What Can NDIS Therapy Providers Do Following the Latest Pricing Decision   One of the best things they can do is participate in Ability Roundtable benchmarking to ensure we have the most robust sector data to inform NDIS pricing decisions (see our most recent post): https://lnkd.in/gGyXjxQm. Participation, particularly in our allied health roundtable community of practice, also helps organisations drive operational improvement and gain insights into performance relative to peers. Just one example of what we can learn is to see what the Ability Roundtable data has to tell us about productivity rates. Below, we look at the median Billed Time of staff (as a proportion of Available Time) of members over a 5-year period, segmented by calendar years. We can see some very illuminating trends: ·     2020 saw a significant increase in the productivity of staff caused by the move to telehealth due to COVID. We saw a sustained peak of Billed Time above 55% as the sector found new ways to provide therapy supports – but this could not last. ·     2021 saw the ongoing impact and fatigue of COVID restrictions on families and providers – with a flattening of productivity, particularly through the middle part of the year. ·     In 2022 our members returned to the long-term upward trend of pre-COVID Billable Time rates. However, the data highlights inconsistency in productivity across the year, with large peaks (up to 55% Billable Time) followed by deep troughs (drops of up to 10%). This variation reflects the difficulty of matching a permanent workforce to volatility in demand. ·     We have recently added the 2023 Billable Time data to this chart, which shows some interesting differences to 2022. After a slow start to 2023 we see the usual steep increase in productivity across the year, peaking around 55% Billable Time. However, the main difference in 2023 is greater consistency in performance month-on-month. This suggests that members are starting to solve some of the inherent issues with delivering therapy supports, particularly during school holiday periods. ·     Yet, as the red highlights show, while overall productivity gains are being achieved year-on-year, member productivity falls back to around 40% each January with the first half of the year delivering lower productivity than the second half: a yearly cycle that undermines sustained improvement to billable time year on year. ·     This characteristic of the therapy market continues: as you can see in the data for the first 3 months of 2024, billable time has not yet broken through 50% by March 2024. These annual cycles will be a topic for our upcoming Allied Health Roundtable National Meeting, to see how members can solve for this. Do you want your organisation to have access to this level of insight and more?  – Contact us through LinkedIn, by emailing michael.bink@abilityroundtable.org or through our website: abilityroundtable.org

Our second post on NDIS therapy providers - this one focuses on what we might learn to drive improved productivity, given there was no price relief (in fact an effective price cut) in the Annual Pricing Review.

📃Scientific paper: Effects of Medicare comprehensive medication review on racial/ethnic disparities in nonadherence to statin medications among patients with Alzheimer’s Disease: an observational analysis Abstract: Background Alzheimer’s Disease (AD) is the mostcommon cause of dementia, a neurological disorder characterized by memory loss and judgment impairment. Hyperlipidemia, a commonly co-occurring condition, should be treated to prevent associated complications. Medication adherence may be difficult for individuals with AD due to the complexity of AD management. Comprehensive Medication Reviews (CMRs), a required component of Medicare Part D Medication Therapy Management (MTM), have been shown to improve medication adherence. However, many MTM programs do not target AD. Additionally, racial/ethnic disparities in MTM eligibility have been revealed. Thus, this study examined the effects of CMR receipt on reducing racial/ethnic disparities in the likelihood of nonadherence to hyperlipidemia medications (statins) among the AD population. Methods This retrospective study used 2015-2017 Medicare data linked to the Area Health Resources Files. The likelihood of nonadherence to statin medications across racial/ethnic groups was compared between propensity-score-matched CMR recipients and non-recipients in a ratio of 1 to 3. A difference-in-differences method was utilized to determine racial/ethnic disparity patterns using a logistic regression by including interaction terms between dummy variables for CMR receipt and each racial/ethnic minority group (non-Hispanic Whites, or Whites, as reference). Results The study included 623,400 Medicare beneficiaries. Blacks and Hispanics ... Discover the rest of the scientific article on es/iode ➡️https://etcse.fr/04bB #alzheimer #science #health

📃Scientific paper: Effects of Medicare comprehensive medication review on racial/ethnic disparities in nonadherence to statin medications among patients with Alzheimer’s Disease: an observational analysis Abstract: Background Alzheimer’s Disease (AD) is the mostcommon cause of dementia, a neurological disorder characterized by memory loss and judgment impairment. Hyperlipidemia, a commonly co-occurring condition, should be treated to prevent associated complications. Medication adherence may be difficult for individuals with AD due to the complexity of AD management. Comprehensive Medication Reviews (CMRs), a required component of Medicare Part D Medication Therapy Management (MTM), have been shown to improve medication adherence. However, many MTM programs do not target AD. Additionally, racial/ethnic disparities in MTM eligibility have been revealed. Thus, this study examined the effects of CMR receipt on reducing racial/ethnic disparities in the likelihood of nonadherence to hyperlipidemia medications (statins) among the AD population. Methods This retrospective study used 2015-2017 Medicare data linked to the Area Health Resources Files. The likelihood of nonadherence to statin medications across racial/ethnic groups was compared between propensity-score-matched CMR recipients and non-recipients in a ratio of 1 to 3. A difference-in-differences method was utilized to determine racial/ethnic disparity patterns using a logistic regression by including interaction terms between dummy variables for CMR receipt and each racial/ethnic minority group (non-Hispanic Whites, or Whites, as reference). Results The study included 623,400 Medicare beneficiaries. Blacks and Hispanics ... Discover the rest of the scientific article on es/iode ➡️https://etcse.fr/RJy #alzheimer #science #health

New Health Affairs forefront article discussing ways for the Centers for Medicare & Medicaid Services #CMS to improve #patientengagement around the #drugpricenegotiation #program of the #inflationredutionact #IRA. I think everyone can (hopefully) agree on these three thing: * It is commendable that #CMS undertook the listening sessions given the tight time-line, lack of a mandate to do so, and considerable other demands on staff time and resources. * The #patientlistening session format for the first #drugprice #negotiation year was not perfect in a lot of ways; some are minor, others more substantive; some are outlined in the article, many others are not... * #CMS seems open to redefining its approach to #patientlisteningsessions, from the session format, to how conflicts of interests are handled, to what questions are asked - and when and how - to how the information collection request (ICR) can best supplement the listening sessions, and so many other questions. The new forefront article outlines some important recommendations for future years that we at the National Organization for Rare Disorders generally agree with. A few key things are missing, however, including how patients and caregivers can best inform #CMS's thinking around therapeutic alternatives and the relative value of a product (in particular in therapeutic areas like immunology or oncology where any given product may suddenly stop working for a given patient and where changing among products when not medically indicated can have severe ramifications for the whole treatment trajectory and significantly destabilize a patient). Similarly, as anyone who has worked in patient preference studies knows, not every patient feels the same way (and individual patient preferences may evolve or change over time), and a lot of logistical questions remain about how these nuanced views can be adequately captured in the listening sessions, including intentionally including adequate representation of patients from historically underserved communities. Finally, effective strategies to streamline, standardize, and reduce the work for CMS - beyond moving the format from drug to disease-specific sessions - are urgently needed. Still, the health affairs forefront article makes a number of great (and in many cases common-sense recommendations) that would meaningfully improve the listening sessions, both for the CMS staff that have to use the output and for the patients, caregivers and providers that participate. Read the full article here: https://lnkd.in/edM3Ub3A

CDI specialists- If you have not signed up for your Medicare Administrative Contractor List-Serve, I highly recommend you take a minute to do so to keep abreast of regular CMS and pertinent MAC updates. Once signed up, invest time in navigating the website, especially the Medical Review section. Each MAC contractor is required as part of the scope of work to perform Medical Review Medical review is the collection of information and clinical review of medical records by Palmetto GBA to ensure that payment is made only for services that meet all Medicare coverage, coding and medical necessity requirements. Medical review activities are directed toward areas where data analyses indicate questionable billing patterns. Per Palmetto GBA- The goal of the medical review program is to reduce payment errors by identifying and addressing billing errors made by providers concerning coverage and coding. To achieve the goal of the medical review program, Palmetto GBA: 1- Proactively identifies patterns of potential billing errors concerning Medicare coverage and coding made by providers through data analysis and evaluation of other information (e.g., complaints) 2- Reviews data analysis reports 3- Takes action to prevent and/or address the identified error 4- Publishes local medical review policies via Local Coverage Determinations (LCDs) to provide guidance to the public and medical community about when items and services will be eligible for payment under the Medicare statue MAC's provide an updated list areas currently under review including Targeted Probe and Educate activities. The best practice for CDI is to stay on top of all relevant TPE areas under review and be proactive in analyzing coding and billing data, identifying potential documentation insufficiencies that must be addressed. Notice under Palmetto, DRGs under review include 470, 291-293, 682-683, and 871-872. Let's not contribute to aberrant patterns of DRG billing through the query process that will not pass the sniff test when audited by the MAC. Be proactive with processes of proactive preemptive denials avoidance documentation. CDI- seek out payer denials for analysis that facilitates processes of CQI in physician documentation. Read payer denial letters and educate physicians on better documentation practices to avoid repetitive denials for the same reason. #CDI, #denialsavoidance, #TPE, #medicalreview, #CQI, #betterdocumentation, Cesar M. Limjoco, M.D. https://lnkd.in/ecSh9Yvk

#MedicareAdvantage plans, how are you thinking about CMS’ 2024 Ruling on Digital Health Literacy? #MedicareAdvantage plans need to: 1. Offer digital health education to improve access to telehealth benefits 2. Identify current enrollees with low digital health literacy 3. Research current trends and successes in identifying enrollees with low digital health literacy 4. Implement a digital health education program to enrollees with low health literacy 5. Collect data on the number of enrollees receiving digital health education and the effectiveness of digital health literacy interventions Check out the 2024 ruling. #medicareadvantage #medicare #digitalhealth #healthliteracy #digitalliteracy #healthequity Lisa K. Fitzpatrick MD, MPH, MPA

In our Q1 2024 quarterly report, review recent developments and triumphs shaping the future of proton therapy. This isn't just about updates; it's about showcasing the critical role proton therapy plays in transforming lives and healthcare systems globally. Dive into the full report to read more about: 📜 Congressional Milestone: The recent "Doctor Fix" law mitigates Medicare payment cuts and extends support for physicians. Learn more about what this means for healthcare. 🏛️ Advocacy Efforts: NAPT is on the front lines, ensuring innovative therapies like proton therapy remain accessible. Discover our efforts to shape healthcare policy. 🚀 Medicare Advantage Reforms: A spotlight on the need for fair prior authorization processes. Get the inside scoop on how changes could benefit patients. 🤝 NAPT in D.C.: Our team met with key policymakers to advocate for proton therapy access. Find out who we're talking to and what we're saying. 💼 Site Neutral Payment Insights: Dive into the debate on equitable payment structures in healthcare. Why does it matter, and what's at stake? 🌙 Cancer Moonshot Initiative: Exciting developments in cancer care accessibility. See how NAPT is involved in this groundbreaking initiative! 📊 MedPAC's Latest Findings: What does the future hold for Medicare payments? We've got the summary you need. 💡 Private Equity Concerns: Understanding the impact of private equity in healthcare. How does it affect you? Curious for more? Head to the NAPT site to read the full report and download your copy today. 🔗 https://lnkd.in/gq3EJKrN